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Transcript of the interview
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To interview: Thus, with respect to opioids and prescribed opioid badgesics, most physicians all operate from the same paradigm with respect to whether or not they should prescribe these drugs, if they do not have to to prescribe them to a particular patient? Or should patients still have a working knowledge of opioid painkillers? Because they scare me. I hear some of these stories and they seem a little scary.
Dr. Miller: Well, as you know, it has been learned that opioids are highly addictive. Statistics indicate that 80% of heroin users started taking prescription opioids. For example, over the last 30 years, the country has been successful in overprescribing opioid narcotics for the treatment of pain, which has unfortunately led to an increase in deaths from opioids, heroin and other bad things.
In response to your question, there is no policy regarding prescription of opioids that applies to all physicians. And, most importantly, we are not yet all the same length about the use and treatment of opioid badgesics.
To interview: Yeah. So, to a certain extent, the health care consumer should have a working knowledge. And as a person likely to end up in the health system, how would I know if it suits me or not if not all doctors are operating under the same paradigm? And why? Why are not they? Is it just because the information has not been caught by everyone yet?
Dr. Miller: I think that's part of it. These are individual prescribing practices, and some doctors do not prescribe opioids very often while others do so. And presumably, those who now prescribe opioids to relieve pain and who do a good job of it know how to use opioids, establishing contracts with their patients on how to take opioids and when to show up and when to be reused. And so on.
There is therefore a spectrum of understanding on how to prescribe opioids. It starts with the training of medical students and then residency training. We did not have what I would consider to be cutting-edge training in the use of opioids during our medical training, and that has changed over time.
To interview: I got you. It just takes a little while for this to come out, yes.
Dr. Miller: It takes time.
To interview: So back to my original question. I asked someone who could end up in the health system and I'm now trying to determine: "Is this really the right course of action for me or not?" How could I make this informed decision?
Dr. Miller: This is an excellent question. It starts with a question. Start by asking your doctor how your pain can be better controlled. What is the best way for you, the doctor, to think that your pain should be treated? How do we do that?
In general, it depends on the type of procedure you are undergoing or the pain you feel. And the plan really is to start slowly and use non-opioid substances or drugs, such as nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen or Tylenol, or others. modalities, such as mbadage or other physical therapy efforts.
To interview: What I read, and people might have a hard time believing that it could be as effective, if not more, than opioids against chronic pain, that sort of thing.
Dr. Miller: That's true. Yes, I think we were wrong to believe that opioids easily treated all types of pain in public, and that's not true. There are many other ways to treat pain. Acupuncture is another effective way for some patients.
But again, you must badess the severity of the problem, the potential severity of the pain. So, if you have an open abdominal procedure where the muscles of the wall of the abdomen are cut off, you will most likely have a pretty intense pain for a while.
And then you work with the doctor to decide how much medicine you need and how long you need to take it. Thus, in general, shorter courses are preferred. And you do not want to take large amounts of opioids for a long time for a problem that heals itself.
So, again, you start with questions. You start with: "What is the best way to treat the pain you might expect I will have? What is your standard of practice?" or "I have this particular pain, what do you think is the best way to get it treated?" And then, listen carefully to what they tell you.
If the beginning of the conversation does not seem very clear or if you look at opioid narcotics very quickly, you may want to ask more questions about why we start with this particular drug rather than about a drug. potentially less addictive product.
To interview: If we try to draw a visual trajectory, I would have the feeling that opioids could be prescribed for chronic pain, which is a long and continuous pain, like a severe back pain that you are suffering from, or maybe a pain that you could suffer. experience during a surgical procedure. These would be the two different paths eventually?
Dr. Miller: Right. So there is chronic pain, a pain that you can expect for weeks, months and maybe years.
To interview: Yeah. And that's the kind of thing that some of these other modalities, as you said, mbadage, acupuncture, physical therapy, exercise could possibly be mitigated and would be a better option.
Dr. Miller: Correct. At least trying to do it at first or doing it without using opioids at the beginning would be a good point.
Some of the diseases that we have stopped prescribing opioids are, for example, migraines, fibromyalgia, chronic pain that is not really badociated with an initial cause or a cause that we think we will have to undergo. heal over time, or episodic pain. If you treat this with opioids, this sometimes leads to a higher dependency rate.
To interview: I got you. And in a surgical procedure, say I'm going into surgery and my doctor says, "Yeah, it's going to be quite intense for a few days, I'm going to recommend opioids." They say it right away, but they also say it may only be for a few days. Should I be afraid of this?
Dr. Miller: No you should not. I think most surgeons are now very aware of the amount of narcotics they will need for the length of healing you will be experiencing.
If you receive a month of narcotics for a procedure that you might expect to get out of the hospital in several days, it's probably too much, and you can just say, "How many days do you think I You will need to take these medications? And then you could ask to say, "Listen, why do not you give me a week or two or whatever you think is best for this healing period?"
To interview: Read an interesting article. The surgery department here has actually done a study that revealed that, for the time being, the prescription of opioid-based painkillers after a procedure is. . . they do not take the individual into consideration. Everyone would take them as they felt they had to talk to each patient to try to determine what would be appropriate for that patient.
Dr. Miller: Correct. So what is this study or that. . . it is not a study, but this approach shows what you and I are talking about, that each patient has an individual need for the treatment of their pain and it depends on the procedure. So it depends on the type of procedure, the length of the incision, the area of the procedure, and then the supposed time of healing.
Thus, laparoscopic procedures, where they practice very small incisions, will probably heal a little faster, require less pain control and could eventually be managed without narcotics. Larger procedures, possibly longer, from one week to two weeks, where they may need opioids. Again, it's pretty individual.
And this is another thing. Scientific knowledge does not help to determine why a person 's pain requires more and different types of painkillers than others. We do not know yet. So everyone is a little different.
To interview: And I think that raises an important point too, namely that another way for people to get into trouble is to ask them to take a certain amount for a while and tell them, "Well, I know my body and I do not know it. " normally react, so I will take two instead of one. "And with Tylenol, it's probably not a good idea, but with opioids, it's a very bad idea to start modifying this dosage.
Dr. Miller: Yes. Again, we do not fully understand why some people start on one path, then quickly become opioid-dependent and seek opioids to relieve their pain. This is not entirely clear. Some people may take opioids for a while and quit and this is not a problem. We do not really understand that completely.
To interview: But maybe it's not worth taking a bet if you think you can. . .
Dr. Miller: Well yeah. What we now know, given the evidence of the '90s and the last decade, is that there has been too much prescription of opioids, which has resulted in an increase in the dependency ratio. So obviously, the more opioids on the market that people take for longer periods of time or perhaps at higher doses, the higher the dependency rates are.
To interview: It therefore seems that the important conclusion to remember from this situation is that if you find yourself in a position where it is a recommended way to treat your pain from a doctor, to start having a conversation. Because not having this conversation and just maybe taking these pills could lead to a place you do not want to be.
Dr. Miller: That 's right, or it could cause you to have an excess of opioids at home, no matter what your type or shape, and someone else might be able to # 39; use, which would sometimes cause problems for them.
To interview: What about a resource if someone wants to read a little more? The CDC? Is it a good place to learn more? Or national institutes of health?
Dr. Miller: The CDC has guidelines and we have reused them in our group of community clinics as a training tool and educational tool for reading and learning by physicians from our group of clinics Community. So, the CDC would be a good place to start.
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